夜尿症を伴ったクローン病の1例

抄録

A sixteen-year-old female, complaining of high grade fever and diarrhea. was admitted to our hospital on June 2nd in 1990. She also had noccturnal enuresis since 12-year-old. From April in 1989,she suffered from soft feces one time a day, and then gradually from watery diarrhea. From May in 1990,she had high grade fever of unknown origin. On admission, severe anemia and mild epigastric tenderness appeared. Laboratory data on admission revealed that severe iron deficiency anemia, inflammatory sign, occult blood in feces and normal ranges of renal functins, anti-diuretic hormone level, urinalysis and urinary osmotic pressure in early morning urine. From findings in small and large intestinal examinations, her disease was diagnosed as Crolhn's disease. Symptoms of Crohn's disease and enuresis rapidly dissolved by ordinary treatments for Crohn's disease, including intravenous hyperalimentation and elemental diet therapies. During four months after discharge, a short-term recurrence of enuresis followed by symptoms and signs of Crohn's disease appeared. There was no evidence of relationships between pathophysiology of these diseases and growth history or mental tests not only at the onset and remisssion but also at recurrence. Therefore, enuresis might be thought as the preceding symptom of Crohn's disease in this case. Several reports have been published concerning bladder dysfunction, except for enuresis, followed by Crohn's disease. In this case, the mechanism by which Crohn's disease might result in enuresis was unclear, but it can be considered the possibility that both severe inflammation in pelvic cavity and bladder dysfunction may be related to the pathogenesis of enuresis. In summary, intraperitoneal organic diseases including Crohn's disease should be taken into consideration in cases with enuresis occurring in adolescence and/or without psychosocial backgrounds.